Impact factors and effect of longer operation time of laparoscopic spleen-preserving splenic hilar lymph node dissection for upper-or middle-third gastric cancer

Abstract

Objective To explore the impact factors and effect of longer operation time of laparoscopic spleen-preserving splenic hilar lymph node dissection (SHLND). Methods The method of retrospective casecontrol study was adopted.The clinicopathological data of the 317 patients with upper-or middle-third gastric cancer who underwent laparoscopic spleen-preserving SHLND at the Fujian Medical University Union Hospital between January 2011 and December 2013 were collected.Median operation time was served as a cut-off point, 148 patients with operation time≥24 minutes and 169 patients with operation time <24 minutes were allocated into the long time group and short time group, respectively.Impact factors affecting the operation time of laparoscopic spleen-preserving SHLND were analyzed firstly, and then operation time affecting clinical effect of patients was explored.Measurement data with normal distribution were presented as ±s and analyzed using an independent sample t test.Count data and univariate analysis were done using the chi-square test.Multivariate analysis was done using the Logistic regression model. Results The gender, body mass index (BMI), number of splenic lobar arteries, type of splenic lobar arteries, number of short gastric arteries and experiences of surgeons were factors affecting longer operation time of SHLND in the univariate analysis (χ2=7. 268, 21. 551, 14. 960, 23. 791, 6. 987, 26. 995, P 0. 05).The mortalities were 0.68% (1/ 148)in the long time group and 0.59% (1/ 169)in the short time group, with no significant difference between the 2 groups (χ2 =0. 009, P >0.05). Conclusion Longer operation time of laparoscopic spleen-preserving SHLND is closely associated with gender, BMI, number of splenic lobar arteries, type of splenic lobar arteries and experiences of surgeons, and it should be performed selectively for inexperienced surgeons in order to reduce operation time and enhance postoperative recovery of patients. Key words: Gastric neoplasms; Spleen; Lymph node dissection; Operation time; Laparoscopy